Minimally invasive thyroid surgery for single nodules: an evidence-based review of the lateral mini-incision technique

Abstract
Background  Minimally invasive thyroidectomy techniques are being developed in an effort to minimize pain, shorten the length of hospital
stay, and improve cosmesis. Various minimally invasive thyroid surgery (MITS) techniques have been shown to be safe and feasible
with some benefits in terms of cosmesis and pain outcomes; however, no single technique has been broadly accepted. This study
was designed to review the evidence in relation to MITS and our experience with the direct lateral mini-incision technique.

Methods  A review of literature published until December 2007 on minimally invasive thyroidectomy techniques was undertaken. Three
issues were addressed: 1) Does MITS provide any benefit compared with conventional open thyroidectomy? 2) Is there any advantage
to the use of endoscopic or video-assisted techniques compared with the direct mini-incision technique? 3) Is the lateral
mini-incision technique safe and efficacious? Additional data in relation to the above issues was derived from a retrospective
cohort study of patients undergoing mini-incision thyroid surgery within our unit.

Results  Issue 1: Five prospective randomized studies and eight studies at a lower level of evidence have demonstrated consistent advantages
of MITS compared with open thyroid surgery in terms of reduced pain and improved cosmesis with equivalent operative safety.
Issue 2: In compiling four level III and IV studies that compared open and video-assisted minimally invasive surgery, there
do not seem to be significant differences in patient satisfaction with the incision. The video-assisted approaches require
significantly longer operative times but also seem to be less painful. Issue 3: Three cohort studies (level IV) have demonstrated
that the lateral mini-incision technique is both safe and efficacious compared with open surgery for hemi-thyroidectomy. Data
from our cohort study of 1281 patients (open hemi-thyroidectomy 1054 vs. MITS 227) confirmed MITS to be a safe and effective
procedure. The rate of postoperative hematoma formation and wound infection was equivalent between groups. The rate of permanent
recurrent laryngeal nerve injury was 0.4% for MITS and 0.3% for CHT and not significantly different (p = 0.7).

Conclusions  MITS has demonstrated advantages over conventional open approaches for both hemi- and total thyroidectomy and the benefits
do not depend on the open or video-assisted approach. For thyroid lobectomies, the lateral mini-incision approach can be performed
with an operative time and postoperative complication profile equivalent to conventional hemi-thyroidectomy while providing
excellent cosmesis with a 2–3 cm scar.

Content Type Journal ArticleDOI 10.1007/s00268-008-9554-4Authors
Raul Alvarado, University of Sydney Endocrine Surgical Unit, Royal North Shore Hospital Department of Endocrine and Oncology Surgery Wallace Freeborn Building St. Leonards NSW 2065 AustraliaTodd McMullen, University of Sydney Endocrine Surgical Unit, Royal North Shore Hospital Department of Endocrine and Oncology Surgery Wallace Freeborn Building St. Leonards NSW 2065 AustraliaStan B. Sidhu, University of Sydney Endocrine Surgical Unit, Royal North Shore Hospital Department of Endocrine and Oncology Surgery Wallace Freeborn Building St. Leonards NSW 2065 AustraliaLeigh W. Delbridge, University of Sydney Endocrine Surgical Unit, Royal North Shore Hospital Department of Endocrine and Oncology Surgery Wallace Freeborn Building St. Leonards NSW 2065 AustraliaMark S. Sywak, University of Sydney Endocrine Surgical Unit, Royal North Shore Hospital Department of Endocrine and Oncology Surgery Wallace Freeborn Building St. Leonards NSW 2065 Australia

Journal World Journal of SurgeryOnline ISSN 1432-2323Print ISSN 0364-2313 (Source: World Journal of Surgery)